1
|
Steenen SA, Linke F, van Westrhenen R, de Jongh A. Interventions to reduce adult state anxiety, dental trait anxiety, and dental phobia: A systematic review and meta-analyses of randomized controlled trials. J Anxiety Disord 2024; 105:102891. [PMID: 38945067 DOI: 10.1016/j.janxdis.2024.102891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
This review evaluates randomized controlled trials (RCTs) intervening on adult state anxiety (fear and emotional distress during dental treatment), chronic dental (trait) anxiety or dental phobia (disproportionately high trait anxiety; meeting diagnostic criteria for specific phobia). Seven online databases were systematically searched. 173 RCTs met inclusion criteria, of which 67 qualified for 14 pooled analyses. To alleviate state anxiety during oral surgery, moderate-certainty evidence supports employing hypnosis (SMD=-0.31, 95 %CI[-0.56,-0.05]), and low-certainty evidence supports prescribing benzodiazepines (SMD=-0.43, [-0.74,-0.12]). Evidence for reducing state anxiety is inconclusive regarding psychotherapy, and does not support virtual reality exposure therapy (VRET), virtual reality distraction, music, aromatherapy, video information and acupuncture. To reduce trait anxiety, moderate-certainty evidence supports using Cognitive Behavioral Therapy (CBT; SMD=-0.65, [-1.06, -0.24]). Regarding dental phobia, evidence with low-to-moderate certainty supports employing psychotherapy (SMD=-0.48, [-0.72,-0.24]), and CBT specifically (SMD=-0.43, [-0.68,-0.17]), but not VRET. These results show that dental anxieties are manageable and treatable. Clinicians should ensure that interventions match their purpose-managing acute emotions during treatment, or alleviating chronic anxiety and avoidance tendencies. Existing research gaps underscore the necessity for future trials to minimize bias and follow CONSORT reporting guidelines.
Collapse
Affiliation(s)
- Serge A Steenen
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands, Amsterdam University Medical Centers, Meibergdreef 5, Room D2-214, 1105 AZ, Amsterdam, the Netherlands; Department of Department of Oral Public Health, ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands.
| | - Fabiënne Linke
- Department of Department of Oral Public Health, ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands
| | - Roos van Westrhenen
- Parnassia Psychiatric Institute, Overschiestraat 55, 1062 HN Amsterdam, the Netherlands; The Institute of Psychiatry, Psychology & Neuroscience, IoPPN, King's College London, United Kingdom; St. John's National Academy of Health Sciences, Bangalore, India
| | - Ad de Jongh
- Department of Department of Oral Public Health, ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands; The Institute of Health and Society, University of Worcester, Worcester, United Kingdom; The School of Psychology, Queen's University, Belfast, Northern Ireland, UK
| |
Collapse
|
2
|
Dignam P, Elshafey M, Jeganathan A, Foo M, Park JS, Ratnaweera M. Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review. Int J Dent 2024; 2024:7712829. [PMID: 38756385 PMCID: PMC11098612 DOI: 10.1155/2024/7712829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background Complications from dental extractions may result in multiple post-operative visits and adversely affect the patient's life. Preventing complications may decrease post-operative morbidity for the individual as well as lower societal costs, such as lost time from work and healthcare costs. Objectives This narrative review aims to assess the prevalence and factors influencing post-operative complications following tooth extraction, helping clinicians minimise the risk. Data Sources. Cross-sectional studies. Study Eligibility and Participants. Patients undergoing dental extractions. Our exclusion criteria included in vitro studies, animal studies, terminally ill patients, and tooth loss not due to dental extraction. Literature was collected from "PubMed" and "Web of Science" through search criteria based on the "PICO" framework. Twenty articles were used to formulate a prevalence table, and 156 articles were included for the factors influencing complications. Study Appraisal and Synthesis Methods. This narrative review was reported using the SANRA (a scale for the quality assessment of narrative review articles) checklist. Due to the scope of our narrative review and its associated objectives, the quality of cross-sectional studies (AXIS) will be conducted from the studies outlining the prevalence. Results Alveolar osteitis appears to be the most prevalent post-operative complication following tooth extraction. Predisposing factors can be significant in their ability to alter the risk of postoperative complications, and clinicians should provide patient-centred care to mitigate this risk. Limitations. Due to the breadth of context, a systematic review was not feasible, as it may have introduced heterogeneity. Conclusion This narrative review has highlighted an array of factors which can influence the prevalence of post-operative complications. Future research would benefit from individually reporting post-operative complications, reducing the heterogeneity in definitions of the complications, and including greater detail on the predisposing factors studied.
Collapse
Affiliation(s)
- Peter Dignam
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Mariam Elshafey
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Aparna Jeganathan
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Magdalen Foo
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Joon Soo Park
- UWA Dental School, The University of Western Australia, Nedlands, Australia
- International Research Collaborative—Oral Health and Equity, School of Allied Health, The University of Western Australia, Crawley, Australia
- School of Engineering, Information Technology and Physical Sciences, Federation University Australia, Victoria, Ballarat, Australia
| | | |
Collapse
|
3
|
Geddis-Regan A, Fisal ABA, Bird J, Fleischmann I, Mac Giolla Phadraig C. Experiences of dental behaviour support techniques: A qualitative systematic review. Community Dent Oral Epidemiol 2024. [PMID: 38680013 DOI: 10.1111/cdoe.12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. AIM To explore and synthesize qualitative literature related to patient experience of dental behaviour support. METHODS A PROSPERO-registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. RESULTS Twenty-three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy-reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. CONCLUSION Qualitative research has been under-utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient-reported experiences of care.
Collapse
Affiliation(s)
| | - Aisyah Binti Ahmad Fisal
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - James Bird
- The Rotherham NHS Foundation Trust, Rotherham, UK
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | | | - Caoimhin Mac Giolla Phadraig
- Department of Child and Public Dental Health, Dublin Dental University Hospital, School of Dental Sciences, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
4
|
Hassan H, Shado R, Novo Pereira I, Mistry M, Craig D. Efficacy and cost analysis of intravenous conscious sedation for long oral surgery procedures. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00084-6. [PMID: 38797651 DOI: 10.1016/j.bjoms.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024]
Abstract
The aim of this study was to determine what is considered a long oral surgery and conduct a cost-effective analysis of sedative agents used for intravenous sedation (IVS) and sedation protocols for such procedures. Pubmed and Google Scholar databases were used to identify human studies employing IVS for extractions and implant-related surgeries, between 2003 and July/2023. Sedation protocols and procedure lengths were documented. Sedative satisfaction, operator satisfaction, and sedation assessment were also recorded. Cost estimation was based on The British National Formulary (BNF). To assess bias, the Cochrane Risk of Bias tools were employed. This review identified 29 randomised control trials (RCT), six cohorts, 14 case-series, and one case-control study. The study defined long procedures with an average duration of 31.33 minutes for extractions and 79.37 minutes for implant-related surgeries. Sedative agents identified were midazolam, dexmedetomidine, propofol, and remimazolam. Cost analysis revealed midazolam as the most cost-effective option (<10 pence per procedure per patient) and propofol the most expensive option (approximately £46.39). Bias analysis indicated varying degrees of bias in the included studies. Due to diverse outcome reporting, a comparative network approach was employed and revealed benefits of using dexmedetomidine, propofol, and remimazolam over midazolam. Midazolam, dexmedetomidine, propofol, and remimazolam demonstrated safety and efficacy as sedative agents for conscious IVS in extended procedures like extractions or implant-related surgeries. While midazolam is the most cost-effective option, dexmedetomidine, propofol, and remimazolam offer subjective and clinical benefits. The relatively higher cost of propofol may impede its widespread use. Dexmedetomidine and remimazolam stand out as closely priced options, necessitating further clinical investigations for comparative efficacy assessment.
Collapse
Affiliation(s)
- Haidar Hassan
- Barts & The London School of Medicine & Dentistry, Queen Mary University, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, 4 Newark Street, Whitechapel, London E1 2AT, United Kingdom; Barts & The London School of Medicine & Dentistry, Queen Mary University, Institute of Dentistry, Royal London Dental Hospital, Turner Street, London E1 2AD, United Kingdom.
| | - Rawand Shado
- Barts & The London School of Medicine & Dentistry, Queen Mary University, Institute of Dentistry, Royal London Dental Hospital, Turner Street, London E1 2AD, United Kingdom
| | - Ines Novo Pereira
- University of Porto, Faculty of Dental Medicine, R. Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal
| | - Manisha Mistry
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David Craig
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
5
|
Starch-Jensen T, Gacic B, Konstantinovic VS, Valls Ontañón A, Sapundzhiev A, Pavlov N, Pechalova P, Szalma J, Mottl R, Tamme T, Tiigimäe-Saar J, Ivask O, Božič V, Jovanovski T, Dovšak T, Țenț PA, Brucoli M, Rocchetti V, Boffano P. Patient's perception of recovery following surgical removal of mandibular third molars. A prospective european multi-center study. J Craniomaxillofac Surg 2023; 51:635-643. [PMID: 37858483 DOI: 10.1016/j.jcms.2023.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/25/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.
Collapse
Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - Bojan Gacic
- School of Dental Medicine, University of Belgrade, Serbia
| | | | | | - Angel Sapundzhiev
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria
| | - Nikolay Pavlov
- University Hospital "St. Georgi", Clinic of Maxillofacial Surgery, Plovdiv, Bulgaria
| | - Petia Pechalova
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria
| | - József Szalma
- Department of Oral Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Radovan Mottl
- Department of Dentistry, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, Hradec Kralove, 500 05, Hradec Kralove, Czech Republic
| | - Tiia Tamme
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Janne Tiigimäe-Saar
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Oksana Ivask
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Veronika Božič
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Trajche Jovanovski
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Tadej Dovšak
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paul Andrei Țenț
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Oradea, Romania
| | - Matteo Brucoli
- Division of Oral and Maxillo-Facial Surgery, Novara University Hospital, Novara, Italy
| | | | - Paolo Boffano
- Division of Dentistry, Vercelli Hospital, Vercelli, Italy
| |
Collapse
|
6
|
Wang L, Yang H, Le X. Comparison of dexmedetomidine with midazolam for third molar surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e33155. [PMID: 37352026 PMCID: PMC10289754 DOI: 10.1097/md.0000000000033155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/25/2023] Open
Abstract
INTRODUCTION The analgesic sedation of dexmedetomidine compared with midazolam for third molar surgery remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexmedetomidine versus midazolam for third molar surgery. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through December 2022 for randomized controlled trials assessing the effect of dexmedetomidine versus midazolam for third molar surgery. This meta-analysis was performed using the random-effect model. RESULTS Four randomized controlled trials were included in the meta-analysis. Overall, compared with midazolam for third molar surgery, dexmedetomidine administration leads to comparable oxygen saturation (standard mean difference [SMD] = 0.25; 95% confidence interval [CI] = -0.24 to 0.74; P = .31), heart rate (SMD = -0.37; 95% CI = -1.18 to 0.44; P = .37), SBP (SMD = -0.24; 95% CI = -0.57 to 0.09; P = .16), DBP (SMD = -0.26; 95% CI = -0.60 to 0.07; P = .12), as well as nausea and vomiting (OR = 0.58; 95% CI = 0.05-6.61; P = .66). CONCLUSIONS Dexmedetomidine may obtain the comparable sedation efficacy with midazolam for third molar surgery.
Collapse
Affiliation(s)
- Ling Wang
- Department of Stomatology, The First People’s Hospital of Chongqing Liangjiang New Areas, Chongqing, China
| | - Hongmei Yang
- Department of Stomatology, The First People’s Hospital of Chongqing Liangjiang New Areas, Chongqing, China
| | - Xi Le
- Department of Stomatology, The First People’s Hospital of Chongqing Liangjiang New Areas, Chongqing, China
| |
Collapse
|
7
|
Li X, Liu Y, Li C, Wang J. Sedative and adverse effect comparison between oral midazolam and nitrous oxide inhalation in tooth extraction: a meta-analysis. BMC Oral Health 2023; 23:307. [PMID: 37210490 DOI: 10.1186/s12903-023-02965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/13/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVE Oral midazolam and nitrous oxide inhalation were commonly used sedative and analgesic techniques during tooth extraction. It is still controversial whether oral midazolam can replace the nitrous oxide inhalation for sedative and analgesic treatment of tooth extraction. Therefore, we conducted this study in order to provide a reference for doctors to choose effective sedative and analgesic treatment in tooth extraction. METHODS We searched the Chinese and English databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang and VIP information databases. RESULTS Through this meta-analysis, we found that the success rate of sedation and analgesia treatment with oral midazolam during tooth extraction was 75.67% and the incidence of adverse reactions was 21.74%. The success rate of sedation and analgesia treatment using nitrous oxide inhalation during tooth extraction was 93.6% and the incidence of adverse reactions was 3.95%. CONCLUSION The use of nitrous oxide inhalation for sedation and analgesia during tooth extraction is very effective, and oral midazolam can be used as an alternative to nitrous oxide inhalation.
Collapse
Affiliation(s)
- Xia Li
- Ambulatory Surgical Center, West China Shool/Hospital of Stomatology Sichuan University, Sichuan Province, No. 14 The Renmin South Road, Chengdu, 610041, China
| | - Yali Liu
- Ambulatory Surgical Center, West China Shool/Hospital of Stomatology Sichuan University, Sichuan Province, No. 14 The Renmin South Road, Chengdu, 610041, China
| | - Chengjun Li
- Ambulatory Surgical Center, West China Shool/Hospital of Stomatology Sichuan University, Sichuan Province, No. 14 The Renmin South Road, Chengdu, 610041, China
| | - Jiexue Wang
- Ambulatory Surgical Center, West China Shool/Hospital of Stomatology Sichuan University, Sichuan Province, No. 14 The Renmin South Road, Chengdu, 610041, China.
| |
Collapse
|
8
|
Wang L, Jing Q, Pei L, Li M, Ruan X, Chen S, Zhang Y, Wan K, Huang Y. Efficacy of continuous intravenous remimazolam versus midazolam in the extraction of impacted wisdom teeth: protocol of a randomised controlled trial. BMJ Open 2023; 13:e067908. [PMID: 37185197 PMCID: PMC10151835 DOI: 10.1136/bmjopen-2022-067908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Benzodiazepines such as midazolam are widely used to moderately sedate patients during impacted wisdom tooth extraction to reduce anxiety in outpatient surgery. This present protocol was designed to determine whether continuous intravenous remimazolam, a new ultrashort-acting benzodiazepine, produces superior postoperative recovery quality to that of midazolam in patients undergoing extraction of impacted wisdom teeth. METHODS AND ANALYSIS This study is a multicentre randomised controlled trial conducted at Peking Union Medical College Hospital, Beijing Anzhen Hospital and Beijing Shijitan Hospital in China. Approximately 150 participants undergoing extraction of impacted mandibular wisdom teeth will be randomly allocated to two groups (remimazolam and midazolam). The participants will be administered standard interventions to ensure they achieve a sedation level of III on the Ramsay sedation scale during the treatment. Preoperative and anaesthesia management and surgical techniques will be standardised for all participants. The primary outcome is recovery time for complete alertness and the secondary outcomes are anterograde amnesia during and after surgery, and interruption during operation for poor compliance or safety concerns. ETHICS AND DISSEMINATION This study has been approved by the Ethics Review Committee of Peking Union Medical College Hospital (approval number: ZS-3142), Beijing Anzhen Hospital (approval number: KS2022082) and Beijing Shijitan Hospital (approval number: 2023-4). TRIAL REGISTRATION NUMBER NCT05350085.
Collapse
Affiliation(s)
- Lejunzi Wang
- Department of Anesthesiology, Peking Union Medical College Hosptial, Beijing, People's Republic of China
| | - Quan Jing
- Department of Stomatology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Lijian Pei
- Department of Anesthesiology, Peking Union Medical College Hosptial, Beijing, People's Republic of China
| | - Mohan Li
- Department of Anesthesiology, Peking Union Medical College Hosptial, Beijing, People's Republic of China
| | - Xia Ruan
- Department of Anesthesiology, Peking Union Medical College Hosptial, Beijing, People's Republic of China
| | - Shaohui Chen
- Department of Anesthesiology, Peking Union Medical College Hosptial, Beijing, People's Republic of China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Kuo Wan
- Department of Stomatology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hosptial, Beijing, People's Republic of China
| |
Collapse
|
9
|
Li X, Tian M, Deng Y, She T, Li K. Advantages of Sedation With Remimazolam Compared to Midazolam for the Removal of Impacted Tooth in Patients With Dental Anxiety. J Oral Maxillofac Surg 2023; 81:536-545. [PMID: 36852757 DOI: 10.1016/j.joms.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Although midazolam is commonly used to sedate patients with dental anxiety, it has shortcomings that reduce the satisfaction of patients and doctors. The aim of this study was therefore to explore the advantages of remimazolam as a sedative. METHODS The study design was a prospective randomized controlled trial. Patients with dental anxiety and who were to undergo impacted tooth removal were randomized into remimazolam and midazolam groups. They were sedated with remimazolam or midazolam prior to receiving nerve blocker. The predictor variable was the type of sedative, while the primary outcome variables were the onset time, awakening time, recovery time, and postoperative side effects. Secondary outcome variables were the Modified Dental Anxiety Scale score before and after surgery, patient satisfaction and comfort levels scores, and doctor satisfaction level scores. Other variables included the patient demographics and the operation time. Data were analyzed using the Student's t-test, Mann-Whitney test, χ2 test, and two-way repeated measurement ANOVA test (SPSS Version 25.0). RESULTS A total of 83 patients were included in this study, with 42 randomized to the remimazolam group and 41 to the midazolam group. There were no significant differences between the two groups in terms of demographic features and operation time. Patients in the remimazolam group had significantly shorter onset time, awakening time, and recovery time compared to those in the midazolam group (each P < .001). Postoperative side effects were more frequent in the midazolam group (P < .001). Following surgery, the Modified Dental Anxiety Scale scores in both groups were significantly lower than prior to surgery (P < .001). Satisfaction levels scores for the patients and doctor were higher in the remimazolam group than in the midazolam group (P < .001). CONCLUSIONS The use of remimazolam results in faster onset, more rapid recovery, and lower incidence of postoperative side effects compared to midazolam, leading to improved satisfaction for patients and doctors. Remimazolam therefore appears to have several advantages over midazolam for the sedation of patients with dental anxiety associated with the removal of impacted teeth.
Collapse
Affiliation(s)
- Xue Li
- Attending Physician, Department of Anesthesiology, Hospital of Stomatology, Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Meijun Tian
- Postgraduate Student, Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Yilan Deng
- Postgraduate Student, Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Tingzhi She
- Professor, Department of Anesthesiology, Hospital of Stomatology, Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Ke Li
- Chief Physician, Professor, Department of Anesthesiology, Hospital of Stomatology, Zunyi Medical University, Zunyi, Guizhou, People's Republic of China.
| |
Collapse
|
10
|
Garip L, Verbist J, Stragier H, Meyns J, Mesotten D, Vundelinckx J. A comparative study of patient satisfaction about anesthesia with dexmedetomidine for ambulatory dental surgery. BMC Res Notes 2022; 15:376. [PMID: 36544143 PMCID: PMC9773427 DOI: 10.1186/s13104-022-06246-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Intranasal administration of dexmedetomidine for monitored anesthesia care (MAC) appears to be an effective, safe, and appropriate alternative to general anesthesia (GA) for ambulatory dental surgery. Based on the available evidence we evaluated a new MAC protocol with intranasal dexmedetomidine as the primary choice. To assess a difference in patient satisfaction and anesthesia-related discomfort between GA and MAC in ambulatory dental surgery, a study was conducted among patients undergoing various dental procedures. Patient satisfaction and anesthesia-related discomfort were assessed on the first postoperative day using the Bauer patient satisfaction questionnaire. RESULTS Although the differences were small, patients in the MAC group were overall more satisfied with the general care compared to the GA group (p < 0.02). Patients in the MAC group reported more postoperative drowsiness compared to the GA group (p < 0.05), but less postoperative hoarseness and sore throat (p = 0.005 and p < 0.001, respectively). Moreover, postoperative thirst was more common in the GA group (p = 0.002). In conclusion, the differences in patient satisfaction and anesthesia-related discomfort between GA and MAC in this implementation study were small but appeared to favor MAC with intranasal dexmedetomidine over GA as anesthesia method during dental ambulatory surgery.
Collapse
Affiliation(s)
- Levin Garip
- grid.470040.70000 0004 0612 7379Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jasmin Verbist
- grid.470040.70000 0004 0612 7379Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Hendrik Stragier
- grid.470040.70000 0004 0612 7379Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium ,grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands ,grid.470040.70000 0004 0612 7379Critical Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Joeri Meyns
- grid.470040.70000 0004 0612 7379Department of Stomatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dieter Mesotten
- grid.470040.70000 0004 0612 7379Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium ,grid.12155.320000 0001 0604 5662Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium ,grid.470040.70000 0004 0612 7379Critical Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Joris Vundelinckx
- grid.470040.70000 0004 0612 7379Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium ,grid.470040.70000 0004 0612 7379Critical Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| |
Collapse
|
11
|
Estimating the Need for Sedation in Patients with Dental Anxiety and Medical Complexities Reporting to Tertiary Care Dental Hospital Using the IOSN Tool. Int J Dent 2022; 2022:5824429. [PMID: 35531571 PMCID: PMC9072058 DOI: 10.1155/2022/5824429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To provide consistent method for assessment of sedation need among patients undergoing dental treatment based on specific risk factors that is dental anxiety, medical status, and treatment complexity of needed dental treatment using IOSN (indication of sedation need) tool for assisting the clinician in decision making process. Methods A total of 237 patients aged ≥12, ASA I and II were enrolled in the study. A structured questionnaire comprising of three sections was distributed among the participants. Section 1 comprises details about age, gender, literacy level, occupation, monthly income, and previous dental treatment history. Section 2 is based on Modified Dental Anxiety Scale which is a questionnaire comprising of five questions ranging from “not anxious” to “extremely anxious.” The third section was based on using the IOSN tool comprising three components: MDAS (Modified Dental Anxiety Scale) rank score, Systemic Health (ASA status) rank score, and treatment complexity rank scores. The total of three scores was then computed to determine the total rank score which suggested the sedation need. History of past traumatic dental experiences was also inquired from each patient. Results A total of 237 patients aged ≥12, ASA I and II were enrolled in the study, out of which 56.1% were female. Statistical analysis was conducted by using the IBM SPSS Statistics 23 software. Based on the MDAS score, 47/237 (19.8%) participants were found to be highly anxious related to dental procedures. 34.6% of the participants showed to have a high sedation need while performing a dental procedure. The sedation need was found to be significantly associated with the female gender with a significant p value of (p=0.016), higher education status (p=0.016), and history of previous traumatic dental experience (p < 0.001). Conclusion A simple assessment tool can enable clinicians in their decision making to identify patients in need for dental treatment under sedation based on patient-specific risk factors such as past traumatic dental experiences. Need for sedation can be assessed by information on patient anxiety level towards dental treatment, medical history, and complexity of planned dental treatment. The IOSN tool is a simple and quick assessment tool that can be applied for preprocedural assessment of sedation need for dental treatment.
Collapse
|
12
|
Does kinesio taping reduce pain, swelling, and trismus after mandibular third molar surgery? A systematic review and meta-analysis. Oral Maxillofac Surg 2022; 26:535-553. [PMID: 34981213 DOI: 10.1007/s10006-021-01025-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
The aim of this study is to provide an evidence-based conclusion regarding the effectiveness of kinesio taping (KT) in reducing postsurgical discomforts after mandibular third molar surgery and critically appraise the available literature. Eligible clinical trials evaluating patients older than 18 years who were treated with any type of KT compared to no taping in which pain, swelling, or trismus scores were reported were included. An electronic literature search was carried out in the following databases to identify relevant papers up to May 30, 2021: Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The effect sizes were calculated using mean difference (MD) and standardized mean difference (SMD). The heterogeneity analysis was conducted using (I2) statistic at alpha = 0.10 (PROSPERO; CRD42021252670). Nine randomized clinical trials with 444 participants were included in the qualitative analysis and eight in the quantitative analysis. The results of the meta-analysis revealed a statistically significant reduction in pain and swelling scores before the 7th postoperative day. On the 7th postoperative day, no significant difference was observed between KT and control groups in terms of pain and swelling. Additionally, KT led to an increase in patients' maximum mouth opening of more than 3 mm in postoperative intervals. KT is effective in reducing postoperative pain within the first 48 h after surgery and improving mouth opening during all postoperative intervals with moderate to high certainty of evidence.
Collapse
|
13
|
Effectiveness of Auditory Distraction and Brief Relaxation Therapy in Reducing Anxiety in Dental Patients Undergoing Extraction: A Randomized Controlled Trial. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12010418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This study compared the effectiveness of auditory distraction and brief relaxation therapy for reducing anxiety in patients undergoing tooth extraction. Methods: A non-blind, three-armed, randomized control trial was carried out. The targeted study population were patients who needed extraction of a non-restorable and non-mobile molar tooth. Eighty-six patients were recruited; the brief relaxation therapy and auditory distraction groups had 32 participants each, while 10 of the 22 participants in the control group were excluded due to missing data. The Hierarchical Anxiety Questionnaire was used to assess the anxiety level. The Mann–Whitney U or Kruskal–Wallis test was performed to compare means between the groups. The before and after comparisons in each group were carried out using the Wilcoxon Signed-Rank test. The alpha value was set at 0.05, and data were analyzed using SPSS version 24. Results: The mean anxiety score after brief relaxation therapy and auditory distraction had significantly decreased (p < 0.001). Although not significant (p = 0.13), there was a slight increase in the anxiety score of the study participants in the control group just before the extraction procedure. Brief relaxation therapy was significantly effective in reducing anxiety scores in comparison to the control group (MD = 5.87, 95% CI = 2.58, 9.17; p = 0.001), but auditory distraction was not (p = 0.14). Conclusion: Both auditory distraction and brief relaxation therapy were effective in reducing patient anxiety before a dental procedure. Furthermore, it would be interesting to learn if these findings remain consistent for more complex dental procedures, such as surgical removal of an impacted third molar.
Collapse
|
14
|
Kim H, Ryoo SH, Karm MH, Seo KS, Kim HJ. Analysis of changes and trends in the use of sedatives in dental sedation using data from the National Health Insurance in Korea. J Dent Anesth Pain Med 2022; 22:49-60. [PMID: 35169620 PMCID: PMC8814723 DOI: 10.17245/jdapm.2022.22.1.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although dental sedation helps control anxiety and pain, side effects and serious complications related to sedation are gradually increasing. Due to the introduction of new drugs and sedation methods, insurance rates, legal regulations, drugs, and methods used for dental sedation are inevitably changed. In the Republic of Korea, National Health Insurance is applied to all citizens, and this study investigated changes in the use of sedatives using this big data. Methods This study used customized health information data provided by the Healthcare Insurance Review & Assessment Service of Korea. Among patients with a record of use of at least one of eight types of sedatives for dental sedation between January 2007 and September 2019 were selected; the data of their overall insurance claims for dental treatment were then analyzed. Results The number of patients who received dental sedation was 786,003, and the number of dental sedation cases was 1,649,688. Inhalational sedation using nitrous oxide (N2O) accounted for 86.8% of all sedatives that could be claimed for drugs and treatment. In particular, it was confirmed that the number of requests for sedation using N2O sharply increased each year. Midazolam showed an increasing trend, and in the case of chloral hydrate, it gradually decreased. Conclusion According to our analysis, the use of N2O and midazolam gradually increased, while the use of chloral hydrate gradually decreased.
Collapse
Affiliation(s)
- Hyuk Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Seung-Hwa Ryoo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
15
|
Gaur S, Marimuthu M, Wahab A, Krishnan N, Ramasubbu S. Twin Mixed Local Anesthesia in Third Molar Surgery - Randomized Controlled Trial. J Oral Maxillofac Surg 2021; 80:63-69. [PMID: 34363764 DOI: 10.1016/j.joms.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction. METHODS A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride + 1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride + 1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7. RESULTS The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus. CONCLUSIONS Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.
Collapse
Affiliation(s)
- Shivangi Gaur
- Post graduate Resident, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Madhulaxmi Marimuthu
- Professor, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India.
| | - Abdul Wahab
- Professor, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Navaneetha Krishnan
- Professor, Department of Anesthesia, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Subhashini Ramasubbu
- Post graduate Resident, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| |
Collapse
|
16
|
Mladenovic R, Djordjevic F. Effectiveness of virtual reality as a distraction on anxiety and pain during impacted mandibular third molar surgery under local Anesthesia. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:e15-e20. [PMID: 33771743 DOI: 10.1016/j.jormas.2021.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to assess the effectiveness of Virtual Reality (VR) in reducing anxiety and pain during impacted mandibular third molar extraction under local anesthesia. METHODS The study was designed as a prospective clinical study covering 74 respondents over 20 years of age. Surgical extraction of both impacted mandibular third molars was performed in two phases, two weeks apart. In the first phase, surgical extraction of the tooth was performed following the standard procedure (Non VR), and in the second phase (VR), we used VR goggles as an auxiliary tool for distraction during the procedure. Face scale was used to assess the level of pain. Heart rate values were recorded by means of wristbands. After both procedures, the patients filled out a modified post-clinical satisfaction questionnaire. RESULTS During the procedure with VR goggles, the respondents had significantly lower pain values during the application of anesthesia, as well as during the surgical extraction of the third molar. There was no statistically significant difference in the level of pain during both surgical procedures with regard to the gender and age. Heart rate values in both phases of the study were not significantly different before the application of anesthesia. When VR goggles were used, the respondents had significantly lower heart rate values before the procedure, as well as during the procedure. Analysis of answers to the post-clinical questionnaire measuring satisfaction with VR technology shows that over 90% of respondents did not experience any VR-related discomfort during the surgery. CONCLUSIONS The VR distraction concept applied during impacted third molar surgery under local anesthesia can help reduce the patients' anxiety and acute pain levels.
Collapse
Affiliation(s)
- Rasa Mladenovic
- Faculty of Medicine, Department of Dentistry, University in Pristina, Kosovska Mitrovica, Serbia; Faculty of Medical Sciences, University of Kragujevac, Serbia.
| | - Filip Djordjevic
- Faculty of Medicine, Department of Dentistry, University in Pristina, Kosovska Mitrovica, Serbia
| |
Collapse
|
17
|
Jaroń A, Jedliński M, Grzywacz E, Mazur M, Trybek G. Kinesiology Taping as an Innovative Measure against Post-Operative Complications after Third Molar Extraction-Systematic Review. J Clin Med 2020; 9:jcm9123988. [PMID: 33317073 PMCID: PMC7763842 DOI: 10.3390/jcm9123988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
There are many randomized clinical trials suggesting a positive effect of kinesiotaping on postoperative swelling. In dentistry, however, the use of kinesiotaping still seems to be innovative, since not many articles on kinesiotaping within the craniofacial area have been published. This study aimed to systematically review and synthesize available controlled trials examining the use of kinesiotaping to reduce morbidity after third molar extraction. Literature searches for free text and MeSH terms were performed using five search engines, and used to find studies which focused on kinesiotaping as a form of rehabilitation after third molar extraction. The keywords used in the search were: “((“molar, third”[MeSH Terms] OR (“molar”[All Fields] AND “third”[All Fields]) OR “third molar”[All Fields] OR (“third”[All Fields] AND “molar”[All Fields])) AND extraction [All Fields]) AND “kinesiology”[All Fields]”. For the assessment of the risk of bias, the Jadad and Maastricht scales were applied. The search strategy identified 317 potential articles. After analysis, 10 papers were included in the final evaluation. Despite the fact that most of the included articles adhered to methodological standards, the fact that there are only a few of them points to a further need for scientific development of physiotherapy in this regard. Kinesiology taping is useful against post-operative morbidity of the third molar extraction site. The present studies show a low level of the risk of bias, but they are limited in number; therefore, it seems that more research is needed.
Collapse
Affiliation(s)
- Aleksandra Jaroń
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.J.); (E.G.); (G.T.)
| | - Maciej Jedliński
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
- Correspondence:
| | - Elżbieta Grzywacz
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.J.); (E.G.); (G.T.)
| | - Marta Mazur
- Department of Oral and Maxillofacial Surgery, Sapienza University of Rome, 00185 Rome, Italy;
| | - Grzegorz Trybek
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.J.); (E.G.); (G.T.)
| |
Collapse
|